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Wednesday, April 27, 2011

MiM Mailbag: Will pursuing medicine dream sacrifice family time?

Dear Mothers in Medicine,

I came across this blog via “A Cartoon Guide to Becoming a Doctor” and have been a frequent reader of yours for a while now. You each give great perspective on what it is like to balance work and family. I am fairly young (22) and planning to apply to medical school within the next year. However, I am concerned about how much time I will actually get to spend with my family (many years down the road since I don’t plan to have children right now) AFTER residency. I figured its going to be hectic and crazy during medical school and residency so lack of family time was a given. I want to go into primary care (pediatrics) but I heard from several medical students and residents that you’re always on call because new mothers call a lot.

My main concern isn’t whether I should go into pediatrics or not….it’s if I should re-think about going to medical school and pursue a PA program instead? All my life, my mom has been busy working to provide for my three sisters and I and was never able to attend any of my extracurricular events. I do want to be a doctor but I don’t know if sacrificing family time outweighs my dreams of pursing medicine. I have the impression (please correct me if I am wrong) that many Physician Assistants have “normal work hours,” which allows them more time with family and friends. I’m worried that if I do go the PA route, I wont be satisfied and will look back and think maybe I should have applied to medical school.

I was wondering if you could please provide some advice…I know that I am not a mother yet, but I will be some day. Thank you so much!

20 comments:

One thing against becoming a PA is that you work for someone else who has control over your schedule. Of course the way medicine is going we may all be working for the government at some point but for now, being a part owner of my practice allows me to be flexible. If I want to go be the mystery reader at my daughter's school or help out with Field day or just go grab lunch with her, I arrange my schedule and do it. Being your own boss has its headaches but it also has its perks as well.

Being in medical school and residency definitely means time awat from family, and that can be very painful. But my medical school has been flexible with allowing me to have time off to be at home with my son as well. There are ways to make it work, but it helps to think outside the box. Choosing a more family-friendly specialty helps as well.

Medical training is all-consuming. On the other hand, once you get past the first two years of medical school, you are taking care of patients, and that is the fun (and frustrating) part. Once you are done with training, however, there are many ways to put your career together that allow you to have time with your family. But I don’t think the basic question should be: “How can I control my hours at work?” but rather “What career will ignite my passion so that I do my best work and make an impact? And how can I fit that career into my other life goals?”

I have a high intensity, busy job in academic medicine, but I also have a huge amount of flexibility. I attend most of my daughter’s games, performances, events, and milestones. Fortunately, these things are valued where I work, and my colleagues routinely help each other out (yes, you can find such a place!). I love my work and I love my family and, even though I never get quite enough time for either, I love my life.

Think about how you want your children to see you. Do you want to be the grumpy mom who works limited hours, but comes home drained and resentful? Or the inspirational mom who shows her children how to make a difference in the world, even though occasionally she misses a soccer game? Once you have a reason to go to work, you can figure out the rest.

This is a very insightful question for someone who is so early in her career. There are many different facets of your question that I want to address.

First, and in my opinion, most important, is whether you would be satisfied with a career as a PA or not. As a PA, you may be able to do some of the same things as a physician, but at the end of the day you will not be a doctor. This is both a positive and negative but is an essential fork in the road when deciding on a career decision. You will likely not be your own boss, and again, this can be good but also has its drawbacks.Once you address this first point then you get into the heart of your question which is, can one balance a family and a career in medicine successfully? The answer for most women would be yes. BUT (in capitals) this takes a whole lot of perseverance, planning and organization, and a good "support staff." PERSEVERANCE: It takes a long time to achieve the end goal and every step of the way can be emotionally draining. You must be commited and focused throughout your training.PLANNING: you will be able to have the family and home life you want in medicine, but you may have to decide what timing works best for you. Many women delay child bearing until after residency. IS this acceptable to you?ORGANIZATION/SUPPORT STAFF: Once you have your family, it is very important to be organized and have help. I am now working 3 days a week in a primary care practice and have 2 kids and 1 on the way. I have balance. AND I am fortunate to have a supportive husband, a dedicated mother in law and a babysitter/nanny that helps me pull it all off. You can't do it alone, or you can, but it wont be enjoyable.Good luck and follow your gut.

I too struggles with this, and ultimately decided to pursue medical school. For me, I needed to challenge, and I had to go after my dream of being a doctor. I didn't plan on starting a family until after my intern year at the earliest....guess what? Someone had a sense of humor and even though I was using Nuva Ring, I found out I was pregnant February of my first year of medical school. I had my son during September of my second year, and I wouldn't change a thing.

Having him has allowed me to interact with even more female doctors who tell me that it isn't easy, but it is definitely doable. My Ob/Gyn is a single mom with a six year old son. She misses very little. She will be the first to tell you that she could make more money if she took more call, but she is very happy with her family life.

So I didn't go straight to med school when I was 21, because of the reasons you gave. I did various other things, including teaching, and it always returned to needing to be in medicine. So I went back at 29, and really wish I'd done it sooner. I do already have my kids, and I'll be starting surgery residency in a couple of months, and it still remains doable, but just barely. My husband tells me that I am much more pleasant while on most of my clinical rotations.

I am a pediatrician. In peds, it's relatively easier to find a part-time job, allowing you to have more time for your family. I work 3 days a week. As for calls, my work has a nurse triage line so that means when I am on call, which occurs about once every 10 days, I don't have to answer those mommy calls at all. Sometimes, I don't get a single page when I'm on call. Of course, your quality of life depends on where you work but it IS possible to achieve life/work balance as an MD.

Great question and so far lots of great replies. I am a PA and a mom. I do work for someone else, which i enjoy - they pay my malpractice and take my after hour calls. My daughter is only 2, so I am not missing many activites while she is at daycare. They give me plenty of PTO, but I have to schedule in advance for time off. My advice is - if you want to be a doctor, go to med school. Being a PA should not be a subsititue because MD training is too ___ (fill in the blank - long, hard,time consuming, needs too many pre-recs, expensive). Two of my classmates from 7 years ago are now back in med school because they realized they should have followed their original dreams. My original dream was nursing, but I wanted to do more than nursing - without going to nursing school - so I found the PA profession. Good luck with your decision Alicia and congratulations on your graduation from college! - Andrea Rodriguez, PA in Texas

You've gotten some great positive advice, most of which I agree with. Here's a couple of other thoughts, though:

Think about how much debt (or not) you will accrue. It is much easier to have a flexible schedule in some of the primary care fields (peds, IM, FP) but they also pay less, particularly if flexibility and/or a part-time schedule are important to you. If you graduate from medical school with $150K in debt, and then are looking at a part-time practice, you may find yourself struggling financially on top of trying to achieve a work/life balance.

Also, look at your motivations for the MD degree- I know many (honestly, myself included) smart overachievers who became doctors, rather than nurses, PAs, or laboratory technicians simply couldn't bear the thought of being a subordinate, of not being in charge, of being 'below' someone else. If this is the motivation for the MD rather than the PA (and I'm not at all saying it is for you!), rethink.

I will tell you that I went to med school at 21, married and before kids, gung ho and determined to be that inspirational model mom who shows her kids what a smart woman can accomplish. Well, I had my first kid during residency and have been lucky enough to have a totally supportive husband and a part-time (4 days/week) job... but, honestly, if I could have a do-over of my 20's, I wouldn't do it again. I like what I do most dyas, but the autonomy is overrated (and honestly, I don't have that much as an employee physician), the pay kind of stinks, I'm still paying off med school and college loans, and I can't ever just close the door and leave my work at work.

I would agree with hh in that I am a better mom in the time I have with my girls than if I did not work. I try to make every minute count with them. It helps that I love my work. Is there ever a good time for balance? No. Can you make it work? Yes. Will it be perfect: high pay-short hours-satisfying job? Only for the rare few.

Follow your career dreams. What if the right man doesn't come along? What if you're infertile? How terrible would it be to put your dream of becoming a doctor on hold for something else that may never materialize. As other posters have pointed out, being a mom plus a doctor is completely doable. It may be hard, but nothing worth doing isn't.

Congrats on graduation! I also had this same dilemma and am currently in Pa school. I enjoy what I am learning but there is a part of me that wants to Learn and do more than a Pa. I think about going back to med school alot! Take your time and make the decision that is best for you! Many people encouraged me to go the Pa route including many doctors, but I have to admit I see myself going back to med school in a couple years! Good luck with whatever you choose!

I can't speak for peds, but in my pathology practice, I can get covered and make it there for most everything - bringing pets for star student week, costume patrol, what have you. I must admit when my kids were younger and I was in residency my time was not my own, and I did miss a lot of those all important developmental milestones (sigh). Sure I miss the occasional soccer game on Sat. when I am on call (like this coming one) but I think most working parents can't make it to everything.

My sister has a PA degree in anesthesia from Emory. She makes as much as any full time family practice doc or pediatrician and has a fabulous lifestyle making almost all of her boys events. She also got to start working two short years after college, getting a big head start on any MD (and enjoying all of those developmental milestones).

I agree, look at all the pros and cons and do what you will enjoy - you can make the rest fit.

I never took Cartoon Doc's cartoons quite so literally. They look like they are intended to be humorous, and I'm pretty sure they are either exaggerated slightly or simplified for artistic effect. Also, read some of Fizzy's other posts. Not *everyone* has the same experience (this is quite evident in the comments!)

I'm weighing in late on this, but I do think you can have a child-friendly career as a pediatrician. A lot of it depends on where you work. You may need to be flexible geographically, but I'm sure you can find a good fit. You may not earn bundles of money if you want to work parttime, but it's certain doable.

I think being a PA is a great career, but you're young enough that you shouldn't settle if you feel you want to be a doctor. If you were 32, married, and wanted to have kids now, I might say something different. I know people have posted here with very positive stories about going to med school with a boatload of kids and I'm sure there are many good stories, but I also know a lot of women who went in that direction and had a lot of regrets.

K: Hopefully, nobody will make any career decisions based on my cartoons! Making a cartoon with the message "med school was great and I loved it" isn't terribly funny.

I'm 27, married, have 2 kids age 6 and 9 (the 6 year old has special medical needs) and I'm a premed undergrad. I've definitely wondered the same thing...it would be easier for me to become a PA, buy I really and truly want to be a doctor, with all that entails. For now, I'm sticking to that path...if something happens that forces me to reconsider somewhere along the line, I'll deal with it then. For you, where you are in your life now, I don't see any reason not to pursue your dream! I know lots of pediatricians with a good balance between work and family.

I was once pre-med and decided (for many reasons) to switch to nursing school. While working full time in a PICU, I went back to school. I am a primary care pediatric nurse practitioner (for the last 12 years) and have never once regretted my decision. I have no school debt (my employer paid for most of my ivy league graduate education), make seriously awesome money, work 18 hours a week in a large inner-city academic hospital, and never, ever miss a single event with my kids. I could care less that in my state I have to have a "collaborative physician". I have my own patients, make my own decisions, write my own rx's, and am happy to be part of a team that respects what I do and how I do it. I work closely with residents, see what they go through, and am so happy that I went the route I did. Good luck with your decision!

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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